CARE COORDINATION, RN - FULL TIME

JumpStart Games, Inc.; Lakeland (FL); Vor Ort; USD 39.000 - 52.000; Vollzeit

Zusammenfassung

JumpStart Games, Inc. in Florida seeks a Registered Nurse to actively participate in managing patients with complex needs, performing telephonic visits for Medicare Wellness, Transitional Care Management, and Chronic Care Management, and developing care plans.

You will work with care teams to support efficient, high-quality care, coordinate with PCPs and specialists, document encounters, and utilize Epic Healthy Planet tools for care coordination.

Qualifikationen

• Florida RN license required.
• Minimum 2 years in inpatient or ambulatory care.
• Proficiency with Excel preferred.
• Strong listening and interpersonal skills.
• Ability to maintain confidences.

Aufgaben

• Interact with patients telephonically for care coordination.
• Assist patients in gaining access to PCP and specialists following protocols.
• Develop goal-driven, individualized care plans for disease management.
• Document encounters and bill for services.
• Utilize technology and Epic Healthy Planet for care coordination.

Kenntnisse

Excel proficiency

Excellent listening

Confidentiality

Problem solving

Multitasking and prioritization

Ausbildung

Florida RN license

Bachelor’s degree (preferred)

Tools

Epic (Healthy Planet)

Jobbeschreibung

Summary/Objective

Responsible for actively participating in the management of patients with complex needs to include conducting telephonic visits for Medicare Wellness, Transitional Care Management and Chronic Care Management. This role requires the ability to develop care plans and assist in the management of “high utilizers”. and identifying barriers in care to assist with successfully managing the patient’s disease state. He or she will work with care teams and patients to support the goals of providing efficient, effective, and quality care to our community.

Description

Summary/Objective

Responsible for actively participating in the management of patients with complex needs to include conducting telephonic visits for Medicare Wellness, Transitional Care Management and Chronic Care Management. This role requires the ability to develop care plans and assist in the management of “high utilizers”. and identifying barriers in care to assist with successfully managing the patient’s disease state. He or she will work with care teams and patients to support the goals of providing efficient, effective, and quality care to our community.

Essential Functions And Responsibilities

• Interact with patients telephonically (audio and video) for care coordination. This may include, but is not limited to: Medicare Wellness Visits, Transitional Care Management, Chronic Care Management, Medication Reconciliation, documentation of patient reported home vitals, and outreach that supports coding efforts and the closure of quality gaps.
• Assist patients in gaining access to PCP and specialist appointments as needed within recommended time frames following provider protocols and scheduling best practices. Participate as an active member of the patient’s care team collaborating with the patient, patient’s family, providers, clinical staff, and outside care entities.
• Develop and implement goal-driven, individualized patient care plans. These care plans will include a focus on disease management and patient empowerment. Educate patients’ families and care-givers in the execution of these care plans. Monitor care plans to review patient’s progress and revise as necessary while continuing to provide education and support as appropriate.
• Document all encounters and patient related discussions. Close documentation in a timely manner. Appropriately bill for services rendered.
• Properly utilize technology in support of patient care. Basic knowledge of Microsoft Office Suite. Utilize Epic Healthy Planet suite of products for the support of care coordination.

Supervisory Responsibility

This position has no supervisory responsibility

Work Environment & Physical Demands

Possesses the physical stamina, cognitive functions and emotional stability essential to meet the demands of a fast-paced, highly productive and often highly stressful work environment

Travel

Local hospitals for rounding on patients and meetings along with Skilled Nursing Facilities.

Requirements

Required Education and Experience

• Registered Nurse license for the State of Florida and two years’ experience working in both inpatient and ambulatory care setting (physician office setting, hospital or Hospice).
• Proficiency with Excel is preferred
• Excellent listening and interpersonal skills
• Ability to maintain confidences
• Must be flexible, resourceful, and able to problem solve
• Must be able to handle multiple tasks simultaneously and set Priorities

Preferred Education And Experience

• Bachelor’s degree, Case Management Certification